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PubMed2000

Endobronchial mass in a patient with Burkholderia pseudomallei infection.

INTRODUCTION: Burkholderia pseudomallei infection, the great mimicker of infectious diseases, has protean clinical manifestations. CLINICAL PICTURE: A 37-year-old man who presented with community-acquired pneumonia affecting the right upper lobe had unremitting fever. Bronchoscopy showed an endobronchial mass in the right upper lobe bronchus. TREATMENT: Intravenous ceftriaxone and oral erythromycin, with empiric antituberculous treatment added later. This was subsequently switched to intravenous ceftazidime and oral doxycycline after the diagnosis was made. OUTCOME: There was resolution of the endobronchial mass. CONCLUSION: This case illustrates a unique and unreported presentation of melioidosis.

Adult↗
PubMed1999

Genotypic and phenotypic relationship in Burkholderia pseudomallei indicates colonization with closely related isolates.

Seven isolates of Burkholderia pseudomallei from cases of melioidosis in human (2 isolates) and animal (2 isolates), cat (one isolate) and from soil samples (2 isolates) were examined for in vitro sensitivity to 14 antimicrobial agents and for presence of plasmid DNA. Randomly amplified polymorphic DNA (RAPD) analysis was used to type the isolates, using two arbitrary primers. All isolates were sensitive to chloramphenicol, kanamycin, carbenicillin, rifampicin, enrofloxacin, tetracycline and sulfamethoxazole-trimethoprim. No plasmid was detected in all the isolates tested. RADP fingerprinting demonstrated genomic relationship between isolates, which provides an effective method to study the epidemiology of the isolates examined.

Animals↗
PubMed2000

Comparison between the antimicrobial susceptibility of Burkholderia pseudomallei to trimethoprim-sulfamethoxazole by standard disk diffusion method and by minimal inhibitory concentration determination.

Melioidosis, an infection caused by Burkholderia pseudomallei, usually occurs in immunocompromised patients and requires prolonged antibiotic therapy. Previously, oral trimethoprim-sulfamethoxazole (TM/SM), an inexpensive and effective drug has been used as a maintenance therapy. The susceptibility of B. pseudomallei to TM/SM by the standard disk diffusion method is very low. However, some patients who were treated with TM/SM as a maintenance therapy despite the in vitro resistance showed good clinical responses. There were no data comparing the susceptibility of B. pseudomallei by the standard disk diffusion method with other quantitative susceptibility tests. The objective of this study was to determine the agreement between the antimicrobial susceptibility of B. pseudomallei to TM/SM by standard disk diffusion and minimal inhibitory concentration determination (MIC). We performed the susceptibility test of 144 strains of B. pseudomallei to TM/SM by both the standard disk diffusion and microbroth dilution MIC. The sensitivity results were 53.5 per cent and 84.0 per cent respectively. The agreement between the 2 tests was very poor (Kappa = 0.14; 95% CI = -0.01 to 0.29). The false resistant rate by the standard disk diffusion test was 67.9 per cent. Further in vitro susceptibility and clinical study are needed to define the interpretive criteria that correlate with clinical response.

Administration, Oral↗
PubMed2001

Clinics in diagnostic imaging (57). Melioidotic prostatic abscess.

A 46-year-old previously healthy man presented with urosepsis and lower urinary tract obstruction. Both urine and blood cultures grew Burkholderia pseudomallei. Intravenous Ceftazidime failed to control the infection. Prostatic abscess formation was first detected by transrectal ultrasonography, and the extent was subsequently delineated by computed tomography. The abscess was drained by transurethral resection, which served to eradicate a possible persistent focus of infection. The diagnosis and management of prostatic abscess, and Melioidosis infection, are discussed.

Abscess↗
PubMedDate not supplied

[Immunobiological properties of Burkholderia pseudomallei and Burkholderia mallei capsular substances].

The biopolymer composition, immunotropic and immunogenic properties of the fractions of B. pseudomallei and B. mallei were under study. The first two capsular fractions of these agents were found to be similar in their biopolymer composition that was indicative of their close relations. At the same time the causative agents of glanders proved to have decreased content of high molecular glycoproteids and LPS fragments. In the causative agents of melioidosis, capsular fractions K3 and K4 were characterized by the domination of proteins with a molecular weight of 42-25 kD. Fraction K4 in B. pseudomallei and fraction K1 in B. mallei had pronounced immunosuppressing properties ensuring the protection of encapsulated microbial cells in the body. The biopolymers forming fractions K1, K2, K3 in B. pseudomallei and fraction K2 in B. mallei were characterized by immunomodulating properties.

Antigens, Bacterial↗
PubMed1992

Cerebral abscesses due to Pseudomonas pseudomallei.

Two cases of cerebral abscesses caused by Pseudomonas pseudomallei are reported. The first case, a 51-year-old women had a sudden onset of progressive right hemiparesis and right facial palsy and died within 7 days. Postmortem examination disclosed brain abscess in association with disseminated infection outside the central nervous system. The second case, a 9-year-old boy displayed cerebral abscesses as an isolated manifestation. Recovery occurred after treatment with ceftazidime. Review of the ten case reports of cerebral melioidosis revealed that the lesion occurred in patients of all ages and was more common in men than in women. The frontoparietal lobe was the most common location. Fever, headache, and hemiparesis were frequent clinical manifestations while seizures, ataxia were uncommon. CT scanning, serum antibody titer along with hemoculture were useful investigate tools. The importance of early diagnosis and prompt treatment is emphasized for this fatal but treatable disease.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Experimental study on the possibility of using live tularemia vaccine to increase resistance to heterologous infection disease].

In experiments on guinea pigs immunized with Francisella tularensis 15, or live tularemia vaccine (LTV), the level of heterologous protective effect to dangerous infectious diseases caused by Yersinia pestis, Burkholderia pseudomallei, B. mallei, Mycobacterium tuberculosis was studied. The study revealed that during the first 4 weeks after the subcutaneous immunization with LTV the level of resistance of the immunized animals to heterologous infective agent reliably increased as indicated by the survival rate of the animals, as well as by the survival time of those killed by infection, in comparison with the controls. Later (on day 150 after immunization) differences in death rate between the groups perceptibly decreased. Nevertheless, the 1 1/2-fold increase of the survival time of the challenged immunized animals in comparison with the controls proved the possibility of using immunization with LTV for the urgent prophylaxis and treatment not only of tularemia, but also of plague, glanders, melioidosis and tuberculosis.

Animals↗
PubMed2004

Laboratory exposure to Burkholderia pseudomallei--Los Angeles, California, 2003.

On July 26, 2003, the Los Angeles County Department of Health Services (LACDHS) received a report that a local clinical laboratory had isolated from specimens Burkholderia pseudomallei, a category B biologic terrorism agent and the causative organism for melioidosis, which is endemic to certain tropical areas. Because laboratory workers had manipulated cultures of the organism, CDC was asked to assist in the subsequent investigation. This report summarizes the results of that investigation, which included assessment of laboratory exposures, postexposure chemoprophylaxis, and serologic testing of exposed laboratory workers. The findings underscore the need to reinforce proper laboratory practices and the potential benefits of chemoprophylaxis after laboratory exposures.

Adult↗
PubMedDate not supplied

[Immune response in experimental animals immunized with Burkholderia pseudomallei surface antigens].

The influence of the chromatographic fractions of B. pseudomallei surface antigenic complex (C, C1, D, H) on immune response in white rats and white mice was under study. These antigenic complexes were noted to produce perceptible stimulating effect on the immune system of white rats, in contrast to that of white mice. The immunization of the mice the above-mentioned fractions suppressed the phagocytic activity of peritoneal macrophages (PM) and slightly enhanced cell-mediated immunity. In experiments on white rats, fraction C induced the growth of specific antibody titers and stimulated the phagocytic activity of PM, as well as the indices of delayed hypersensitivity (DH). Fraction D showed a lower level of the induction of the phagocytic activity of PM and was inactive in the manifestation of cell-mediated immunity, but induced a high level of humoral immunity. Antigenic complexes C1 and H increased the phagocytic activity of PM and DH characteristics with a low level of antibody production. The studied fractions of the causative agent of melioidosis decreased the content of bactericidal cationic proteins (BCP) in rat blood neutrophils, and in mice a decreased content of BCP in phagocytes was registered. The fractions increased the activity of myeloperoxidase in blood neutrophils in mice and rats. As revealed with the use of immunoelectrophoresis, SDS PAAG electrophoresis and immunoblotting, the surface antigenic complex contained proteins of 18, 22, 39 kD and glycoproteins 42, 55, 90 kD. The latter glycoprotein was found in all the fractions under study, having protective properties.

Animals↗
PubMed2004

Transmission of Burkholderia pseudomallei via breast milk in northern Australia.

Two cases of maternal to child transmission of melioidosis are reported from Australia's tropical north. One infant died of overwhelming sepsis. Both lactating mothers had mastitis. In 1 case, Burkholderia pseudomallei isolated from breast milk was identical on pulsed-field gel electrophoresis with that in blood and cerebrospinal fluid isolates from the infant.

Adult↗
PubMed2005

An electronmicroscopic study of the interaction of Burkholderia pseudomallei and human macrophages.

B. pseudomallei has been shown to persist intracellularly in melioidosis patients until reactivated by decreasing immunocompetence. We have shown by transmission electron microscopy the internalization of B. pseudomallei by human macrophages via conventional phagocytosis enclosed within membrane-bound vacuoles or phagosomes. Ferritin labeled lysosomes provided evidence of phagosome-lysosome fusion. Ingested bacilli were designated as "intact" or "damaged" on the basis of their ultrastructural features. An intact bacterium was seen with low electron opaque central nuclear region surrounded by dense bacterial cytoplasm, bounded externally by bacterial plasma membrane and cell wall. In contrast, B. pseudomallei were considered damaged when seen with cavitation within the central nuclear region, separation of bacterial cytoplasm from the cell wall, herniation of cytoplasmic contents and lamination of bacterial cell wall and its surrounding electron transparent zone. Our observations indicate that the microbicidal mechanism(s) in B. pseudomallei-infected macrophages failed to ensure complete clearance of the organism and this failure probably facilitates intracellular persistence and proliferation, and this may be one of the survival strategies adopted by this organism.

Burkholderia pseudomallei↗
PubMed2006

In vitro motility of a population of clinical Burkholderia pseudomallei isolates.

Melioidosis, a serious infection caused by Burkholderia pseudomallei, is a leading cause of community-acquired sepsis in Northeast Thailand, and the commonest cause of death from community-acquired pneumonia in the Top End of Northern Australia. The causative organism is a Gram-negative, motile bacillus that is a facultative intracellular pathogen. B. pseudomallei flagella have been proposed as a possible vaccine candidate and putative virulence determinant. Flagella expression was highly conserved for 205 clinical B. pseudomallei isolates, as defined by in vitro swim and swarm motility assays. No association was found between motility and clinical factors including bacteremia and death.

Animals↗
PubMedDate not supplied

Pyaemia in pigs.

Pyaemia is by far the most important cause of condemnation in pigs slaughtered in Singapore abattoirs. Between 1983 and 1987, 1757 from a total of 4,899,731 pigs were condemned by meat inspectors for pyaemia, accounting for 0.036% of the total condemnations. The common post-mortem findings of affected pigs during the 5-year period are presented. Abscesses were most commonly seen in the liver (22%), spleen (21%), gastrohepatic lymph node (20%) and bronchial lymph node (17%). Pseudomonas pseudomallei was the most predominant organism isolated, accounting for 39% of the pyaemic cases. The public health significance of abscesses in pigs is discussed with particular reference to melioidosis.

Abattoirs↗
PubMed1991

Respiratory infections transmitted from animals.

The physician's approach to the differential diagnosis of obscure, atypical pneumonias has changed. The physician needs to expand the diagnostic search when confronted with a perplexing, progressive atypical pneumonia. Diseases examined in this article include anthrax, psittacosis, Q fever, tularemia, pasteurellosis, melioidosis, Rocky Mountain spotted fever, and the plague.

Animals↗
PubMed1987

In-vitro susceptibility of Pseudomonas pseudomallei isolated in Malaysia to some new cephalosporins and a quinolone.

The current drugs recommended for treatment of melioidosis are tetracycline, chloramphenicol and cotrimoxazole. Unfortunately these drugs are not the drug of choice in an acutely ill patient with septicaemia prior to the availability of laboratory results. With the discovery of the new cephalosporins which have a broad spectrum of activity clinicians are using them either alone or in combination with other antibiotics in such critical situations. Hence, an in-vitro study was carried out on the susceptibility of 41 strains of P. pseudomallei isolated in Malaysia, to these new cephalosporins and a new quinolone. The results showed that all the cephalosporins tested had some activity on the strains tested, with ceftazidime being the most active drug. Pefloxacin had very poor activity. However, further clinical studies are required to determine the duration, dosage and in-vivo activity of the antibiotics.

Cephalosporins↗
PubMed1985

Pseudomonas pseudomallei in southern Thailand.

The distribution of Pseudomonas pseudomallei was studied in soil and water from various sources of Songkla province, Southern Thailand. P. pseudomallei was isolated from the surface soil of rubber plantations (60.9%) and from the bottom sediments of rice fields (78.1%). Farmers and plantation workers will have a greater risk of contracting melioidosis.

Disease Reservoirs↗
PubMed1975

Pseudomonas pseudomallei: II. Laboratory and experimental studies in animals.

The cultural, biochemical characteristics and antibiotic sensitivity of strains of Pseudomonas pseudomallei isolated from four cases of melioidosis admitted to Ramathibodi Hospital are described. The organisms were gram-negative bacilli often with bipolar staining. The colonies were wrinkled when incubated for long periods. The characteristic non-specific uptake of dye from media into the colonies and their musty or earthy odour rendered them easily distinguishable from other organisms. All strains were sensitive to chloramphenicol and all but one were sensitive to tetracycline. All strains were resistant to colimycin and gentamicin. The pathogenicity of the strain isolated from a fatal case of peritonitis was studied in guinea pigs. The findings showed that following a large inoculation intraperitoneally, the animal developed acute septicaemia and died shortly afterwards. Only a few micro-abscesses were found on the surface of the liver. Chronic infection of longer duration occurred when a small number of organisms were introduced through a cutaneous abrasion. The lesions included pneumonitis and multiple abscesses of various organs including subcutaneous tissue, liver, spleen and mediastinum.

Adrenal Glands↗
PubMed1978

Latent and chronic infections imported from Southeast Asia.

This review is intended to remind physicians of exotic infections with latency of at least one year that could cause illness in refugees or US citizens exposed in Southeast Asia. Tuberculosis, melioidosis, and leprosy are the major chronic infections of bacterial origin. Intestinal protozoa, roundworms, and flatworms are considered with regard to pathogenic, potential and duration of infection. Malaria, filariasis, and schistosomiasis may be seen on occasion. Paragonimiasis and Chinese liver fluke infections are more common and may simulate other less exotic diseases.

Asia, Southeastern↗